RWL #236
Greetings from the University of New Hampshire! What a week! I have been out visiting students and been to sites in Massachusetts (Medford, Quincy, Peabody, Pembroke, Andover, Beverly), Maine (Scarborough), and New Hampshire (Milford). I’ve had a chance to meet some alumni of our program and see some new facilities I have never visited. For the next two weeks, that’s most of what I’ll be doing - driving hither and yon. Lots of windshield time, but it’s great to see the students flourishing, meet their preceptors in person, and see new organizations.
This week I have a loose theme of transitions and identity. The topics range from gender affirming surgery in prison, becoming an American citizen, becoming a doctor, and incorporating traditional medicine into healing. It’s a pretty cool set of pieces - I hope you enjoy them!
I also received an invitation to write a piece for the American College of Healthcare Executives’ CEO Newsletter based on my presentation last March on Creating a Culture of Mentorship. My basic theory is that organizations that embrace mentorship are more cohesive and better places to work. I’m interested in hearing from you on your thoughts on a culture of mentorship. Have you worked in an organization that embraced mentorship? What did that look like? How was it encouraged? What was your experience? If you’re a leader, how do you try to encourage mentorship? If you’re game, I’d love to get your answer here:
https://unh.az1.qualtrics.com/jfe/form/SV_eKXvNWwOmxch3GS
Till next week, enjoy the links and stay well!
(The sketch above is a one-line drawing of me going down I-95 to visit my students in The Adventure Van. I call it The Adventure Van because it’s got 183,000 miles on it and I’ve been driving it for 17 years. It’s been all over the place and it still loves to go, go, go!)
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Read
What: Wired, Prisoners, Doctors, and the Battle Over Trans Medical Care
Why: I believe that a key measure of a society’s advance is how much latitude it gives its citizens to live in ways that are most affirming to them. Primitive societies tend to have very rigid and limited roles - based on age and sex, but also social constructions such as gender and caste. One only needs to look at places like Saudi Arabia to see women not allowed to go out in public without being fully covered, not allowed to drive a car, or hold a job outside of the home. As societies advance, those roles become more flexible and/or dissolve. In the United States and most Western countries, individuals have great latitude to live as they wish, though there are still formal and informal limitations on individuals. Gay marriage became the formal law of the land in 2015 - something that was inconceivable when I was a kid coming of age in the 80’s. This allowed a whole set of individuals to live lives that were not possible prior to that change. Formal and informal institutions had to change around that change. Many employers led the way, even before the law changed, to recognize same-sex partners for benefits for example. Religious organizations, which tend to be fundamentally conservative (small “c”), are still catching up. The recognition of gay marriage will likely pave the way to polyamorous marriage. I think the formal (legal) and informal (cultural) challenges of recognizing polyamorous (i.e., multiple partners - 3 or more) marriages will be much more complicated than recognizing gay marriage, but eventually we will get there. Polyamorous marriage isn’t for everyone, any more than gay marriage is, but at some point our society will advance enough to absorb that complexity. Complexity makes a society richer, with more possibility, but also requires more advanced rules and traditions to accommodate that complexity.
The movement for trans rights has been a lightning rod in politics over the last few years. In my mind, this is a sign that our society is advancing to a more inclusive and rich stage. I support trans rights in general, but part of the process of creating a new set of rights is figuring out what needs to be changed in order to accommodate the expansion of rights. For example, the question of what to do with trans athletes, in particular trans girls entering athletic contests against biological girls, has real issues. I don’t have an answer to that problem, but it will eventually be worked out. The process of expanding rights is usually complicated and emotional, and that is what we are seeing.
So why this article? It presents a double complication of dealing with the trans population in prison. Prison creates a set of challenges for healthcare in general because once you take away an individual’s ability to care for her/himself, you take on the responsibility to provide that care - whether that is clothing, food, shelter, or medical care. Prisoners must be provided basic medical care - so the question raised in this article is whether gender affirming surgery is basic medical care. The article is a bit of a hit piece on a psychiatrist who argues that gender affirming surgery is not basic medical care, and the author mentions at one point that they are in a partner-relationship with a trans person, but it is an interesting account of the conflict. I have not studied the issue of gender affirming surgery, so I do not have a strong opinion on whether it should be regarded as a necessary or elective procedure. If it is necessary, then it should be covered by insurance, to include government programs like prisons. If it is elective, then the individual should bear the cost. Asking this question in the context of prison adds to the complexity, and that makes for an interesting ethical question that reflects the progress of social change. I don’t know that we will land at a point where gender affirming surgery is medically necessary or not, but I suspect we will.
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What: National Review, Charles C. W. Cooke: Ten Years in America
https://www.nationalreview.com/2021/06/ten-years-in-america/amp/
Why: I started listening to National Review’s The Editors podcast shortly after Trump won the presidency. I realized that I had built a media bubble that was primarily left/Progressive-leaning, and as a result, Trump’s win was a complete surprise. I added The Editors to diversify my world view. While I still maintain my Progressive feed (I subscribe to the Washington Post, for example), I have found that adding this diversification has been valuable for understanding political conflicts and actions. I say all this because Charles Cooke is a member of the podcast and has become my favorite commentator on the podcast. He’s British by birth, and speaks with a British accent, but is now an American citizen. He writes affectionately about his appreciation of America, and about becoming an American in this post. It’s a nice reflection on identity and identity transition.
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Watch
What: TEDxAugusta, How culture connects to healing and recovery | Fayth Parks (15 min)
Why: Parks fits into what I would consider to be a complementary and alternative medicine (CAM) practice. She states healing traditions “include a patient’s role in connecting to abelief system that connects to and promotes good thoughts, feelings, and behaviors.” She discusses how traditional, cultural practices complement a medical model of treatment, such as prayer and song.
I think this video connects to the Wired piece above in terms of considering the necessity of gender affirming surgery. The “affirming” component of gender affirming surgery implies that the surgery is intended to connect an individual to a positive system of “good thoughts, feelings, and behaviors.” Parks gives examples that connected her to her ethnicity, affirming her identity and sense of belonging as part of the healing process. But I think her talk also connects in the sense of expanding what our society accepts and valorizes as healing. Much of medicine is linked to a patient’s belief. If a patient has a strong belief that they will recover, and feels they are cared for, they are more likely to recover. We also still don’t know why some treatments work - we just know that they do. Opening to the practical wisdom of healing traditions can only enrich our understanding of health.
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Listen
What: Health Leader Forge, Dr. Neil Meehan, Chief Physician Executive, Exeter Health Resources (full is 85 min; abridged is 45 min)
https://healthleaderforge.blogspot.com/2021/07/dr-neil-meehan-chief-physician.html
Why: Truth in lending - the pandemic really drained my desire to work on the podcast. I’ve been spotty about getting interviews and producing over the last six months. My preference has always been, as much as possible, to go to my guest and interview her/him on site. I was glad to have Dr. Neil Meehan on my podcast to break things up and kick me back into gear. I’ve worked with Neil for several years on the New Hampshire Physician Leadership Development Program , so I’d had the opportunity to hear many of his stories about making the transition from clinician to clinician-leader. In this podcast, Neil tells his own origin story of becoming a physician, and then transitioning to leadership roles. In the full-length version of the podcast, Neil talks about the experience of medical school and residency, and then he draws lessons from that training to talk about how physician training runs counter to the mind-set necessary to be successful as an organizational leader. The abridged version cuts out the discussion of training and jumps straight to the discussion of the challenges. This is a great conversation for anyone thinking about going to medical school, or for clinicians who are thinking about transitioning to leadership roles.
Thanks for reading and see you next week! If you come across any interesting stories, won't you send them my way? I'd love to hear what you think of these suggestions, and I'd love to get suggestions from you. Feel free to drop me a line at mark.bonica@unh.edu , or you can tweet to me at @mbonica .
If you’re looking for a searchable archive, you can see my draft folder here: https://drive.google.com/drive/folders/1jwGLdjsb1WKtgH_2C-_3VvrYCtqLplFO?usp=sharing
Finally, if you find these links interesting, won’t you tell a friend? They can subscribe here: https://markbonica.substack.com/welcome
See you next Friday!
Mark
Mark J. Bonica, Ph.D., MBA, MS
Associate Professor
Department of Health Management and Policy
University of New Hampshire
(603) 862-0598
mark.bonica@unh.edu
Health Leader Forge Podcast: http://healthleaderforge.org
"Were there none discontented with what they have, the World would never reach anything better." - Florence Nightingale